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Scientific Misconceptions and Myths Perpetuated in the 2017 Texas Legislative Session

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Scientific Misconceptions and Myths Perpetuated in the 2017 Texas Legislative Session ISSUE BRIEF 10.23.18 Scientific Misconceptions and Myths Perpetuated in the 2017 Texas Legislative Session Melody T. Tan, Baker Institute Graduate Intern Kirstin R.W. Matthews, Ph.D., Fellow in Science and Technology Policy, Center for Health and Biosciences 2017-18 (1.07%) (Matthews and Tan 2018; VACCINE EXEMPTIONS IN TEXAS TX DSHS 2018b). Vaccines and vaccine exemptions have Vaccine exemptions were a become increasingly contentious issues in controversial subject during the 85th Texas Texas, with pro- and anti-vaccine groups legislative session in 2017. They were contesting several vaccine-related bills addressed in House Bill 2249 (HB 2249) and in the state legislature during the 2017 House Bill 1124 (HB 1124). While neither of session. There are two types of exemptions these bills moved forward, the arguments for vaccines: medical and nonmedical. presented by witnesses during the hearings Medical exemptions are issued by a for the bills provide insight into key physician, who states that the required objections raised by anti-vaccine advocates. vaccine is “medically contraindicated or HB 2249, “requirements for and the poses a significant risk to the health and transparency of epidemiological reports well-being” of a child or someone in their and immunization exemption information household (TX DSHS 2018a). Examples and reports,” required the state to report of medical contraindications include NME rates at the school level, as opposed having HIV/AIDS, a compromised immune to the current school district level. This bill system, or a life-threatening allergy to received a hearing on April 11, 2017, and any component of the vaccine (CDC 2018a; was voted out of the committee, although Rubin et al. 2014). These exemptions, it was not voted out of the chamber by the With adherence to unless otherwise specified, are only valid end of the session (Texas HB 2249 2017). the recommended for one year (TX DSHS 2018a). In contrast, This hearing included 35 witnesses with 12 immunization schedule, stating support, 22 opposing the measure, nonmedical exemptions (NMEs) can be herd immunity can be requested by a child’s legal guardian and one witness testifying ‘on’ the bill. who refuses vaccinations based on HB 1124, “claiming an exemption from maintained, protecting personal beliefs, including religious and required immunizations for public school the entire population conscientious objections. Unlike medical students,” intended to make it easier to from disease. exemptions, NMEs are valid for two years. obtain vaccine NMEs. This bill received a Medical and nonmedical exemptions to hearing on April 25, 2017, but subsequently vaccine requirements have been permitted died without a committee vote at the in Texas since 1972. In 2003, the state end of the session (Texas HB 1124 2017). started allowing conscientious exemptions; Twenty-nine witnesses were reported as since then, Texas shows a steady increase testified in the hearing, with one stating in the number of NMEs from 2,314 (0.08% support, 24 opposing the measure, and the of all students) in 2003-4 to 56,738 in remaining four witnesses testifying ‘on’ the RICE UNIVERSITY’S BAKER INSTITUTE FOR PUBLIC POLICY // ISSUE BRIEF // 10.23.18 with one dose and 97% effective with FIVE MAJOR MISCONCEPTIONS ABOUT VACCINES two doses (CDC 2018c). The diphtheria, tetanus, and pertussis (DTaP) vaccine is 1. Vaccines are ineffective. 80-90% effective (CDC 2017a). The 1995 implementation of a vaccination program 2. Herd immunity is a myth or does not exist. for varicella (chicken pox) reduced incidence, hospitalizations, and deaths by about 90% 3. Vaccines ‘shed’ and cause the spread of disease, endangering the in the first decade after implementation medically fragile. (Leung, Bialek, and Marin 2015; Lopez et al. 2011; Marin, Zhang, and Seward 2011). 4. The consequences of vaccine-preventable diseases are minor, while However, witnesses often cited the vaccines frequently cause injury and death. relatively low effectiveness of the influenza vaccine, with one witness noting that “the 5. Vaccine-exempt children are not spreading disease. 2015-2016 flu shot was only 48% effective” (HB 1124-08).1 While the effectiveness of the flu vaccine is low, it is an outlier not the norm (CDC 2018d; Jackson et al. 2017). The bill. Several witnesses were against school- influenza virus mutates quickly, and a new mandated vaccines as well as the bill itself. version emerges annually. Unfortunately, In this issue brief, we describe the the strain used for the influenza vaccine is key scientific misconceptions presented developed months before flu season starts by vaccine opponents during the witness based on researchers’ best predictions, and testimonies for HB 2249 and HB 1124. the strain used for vaccines does not always Transcripts from the two hearings were match the strain that later circulates (WHO reviewed, and scientific misconceptions 2017). Therefore, effectiveness rates of flu and misinformation were identified, vaccines vary and are not as high as other analyzed, and compared to current nonseasonal vaccines, such as those for evidence in the scientific literature. Our DTaP and MMR. results found that vaccine opponents One witness further implied that promoted several scientifically questionable vaccines can increase disease rates, saying ideas, with five major misconceptions “from the time they started the [polio] identified: 1) vaccines are ineffective, 2) vaccine trials, you see a spike up [of the >99% disease]” (HB 2249-08). However, this is herd immunity is a myth, 3) vaccines ‘shed' Measles incidents decreased and cause the spread of disease, 4) the false (see Figure 1). Polio epidemiology data annually from 530,217 to 85 impacts of vaccine-preventable diseases show an overall decrease in U.S. paralytic after the introduction of are minor, and 5) vaccine-exempt children polio cases after both the introduction of the MMR vaccine. are not spreading disease. the inactivated poliovirus vaccine in 1955 and the oral poliovirus vaccine in 1961 (Nathanson and Kew 2010). MISCONCEPTIONS Several witnesses also challenged the effectiveness of vaccines, asserting MISCONCEPTION 1: Vaccines are ineffective. that “vaccination does not always REALITY: Childhood vaccines have high rates provide immunity” and “vaccines do not of effectiveness. immunize; they interfere with the common One common misconception repeated immunological response to the respected during the witness testimonies was that diseases after subsequent exposure” (HB vaccines are ineffective. On the contrary, 2249-05; HB 2249-03). One of these most vaccines have extremely high witnesses stated that “two of my children effectiveness rates. The inactivated polio had the full HepB schedule of vaccines, and vaccine is 90% effective with two doses both them have lab confirmation of zero and 99-100% effective with three doses antibodies to HepB” further claiming that (CDC 2018b). The measles, mumps, and “they are also not immune” (HB 2249- 05). Several others were concerned that 2 rubella (MMR) vaccine is 93% effective SCIENTIFIC MISCONCEPTIONS AND MYTHS PERPETUATED IN THE 2017 TEXAS LEGISLATIVE SESSION children who get vaccinated but fail to the 1960-70s through a mass vaccination produce antibodies or gain immunity will program in endemic countries (Lane 2006). become immunocompromised. Research on Japanese school children These statements highlight a vaccinated for influenza demonstrated misunderstanding of how vaccines and protection and reduced influenza mortality the immune system work. Vaccines among older members of the population. mimic an infection so that the body learns Furthermore, after vaccination requirements how to fight off a future infection. After were removed and vaccination rates among vaccination, the body stimulates immune schoolchildren decreased, excess mortality cells (T and B lymphocytes) to mount a rates increased (Reichert et al. 2001). specific adaptive immune response against Another misconception about herd the virus, which helps the body remember immunity is that it is only a theory and does how to defend against future infections not exist in reality. This argument appeared (Alberts et al. 2015). Scientific research and more frequently during the legislative experiments do not support the belief that hearings. One witness alleged that because vaccination causes immunosuppression. vaccines wear off, the population does not In fact, it is generally recommended that benefit from herd immunity, claiming that inactivated vaccines can be safely given to “if all adults in this room right now have immunocompromised patients (Kroger et al. not continued to be vaccinated, receive 2011; Sobh and Bonilla 2016). boosters...then we are not all immunized” (HB 1124-08). Similarly, another witness MISCONCEPTION 2: Herd immunity is a myth claimed that “vulnerable children...are or does not exist. already surrounded by numerous adults REALITY: Having a significant portion of the public immunized protects people who are immunocompromised, including infants, the FIGURE 1 — PARALYTIC POLIO CASES DECREASE IN THE U.S. AFTER elderly, and patients undergoing treatment THE VACCINE WAS INTRODUCED IN 1955 (SHOT) AND 1961 (ORAL) for immune diseases and cancers. Herd immunity occurs when the prevalence 1955 of immunity in a vaccinated population Inactivated poliovirus vaccine prevents transmission of infectious agents, 10.0 thereby offering indirect protection to unvaccinated individuals. Another recurring theme in the witness testimonies is skepticism
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